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Contract Number Brand Code Brand Name Active Ingredient Trade Name Package Size Formulary Category Pkg Price Unit Price Unit Description Max. Reimbursable Quantity / Month Package Description Manufacturer Code Manufacturer Name Agent Code Agent Name Benefit Therapeutic Code Therapeutic Desc Drug Contract Start Date Drug Contract End Date Status Description Default Route Max Repeats Therapeutic Head Amend Date
40 2371H OXOZOLIN 0.05% NASAL DR (ARP/AHI) OXYMETAZOLI OXYMETAZOLINE OXOZOLIN 10ML A 4.57 4.57 NASAL DROP 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5232 EENT VASOCONSTRICTORS 2022-04-01 2024-03-31 NASAL 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 2371H OXOZOLIN 0.05% NASAL DR (ARP) OXYME OXYMETAZOLINE OXOZOLIN 10ML A 4.95 4.9473 BOTT 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5232 EENT VASOCONSTRICTORS 2024-04-01 2026-03-31 NASAL 0 EENT VASOCONSTRICTORS
41 2371M AFRIN 0.05% NASAL DR (BSP) OXYMETAZOLINE (C) OXYMETAZOLINE AFRIN 15ML C 13.46 13.4557 BOTT 1 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 5232 EENT VASOCONSTRICTORS 2024-04-01 2026-03-31 NASAL 0 EENT VASOCONSTRICTORS
40 2373G OXOZOLIN PAED 0.025% NASAL DR (ARP/AHI) OXYME OXYMETAZOLINE OXOZOLIN PAED 10ML A 4.05 4.05 NASAL DROP 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5232 EENT VASOCONSTRICTORS 2022-04-01 2024-03-31 NASAL 0 EYE, EAR, NOSE AND THROAT PREPARATIONS